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There are some combinations that just go great together: Peanut butter and jelly, wine and cheese, baseball and hot dogs, Abbot and Costello … But toothaches and airplanes will not be joining this list because they are a terrible combination. (One could say there is little a toothache actually goes well with, but that makes for a boring post.) Truthfully, if you’ve ever flown with a toothache, you know how painful it can be. In my time as an NYC-based Cosmetic Dentist, I’ve been asked about this topic a lot. For many people, being on an airplane can intensify a toothache greatly. In fact, flying can even bring out pain in a tooth that has not previously bothered you. Although, it might not even be your tooth that is hurting. So let’s take a look at flying and toothaches, and see exactly why this combination is so bothersome to some people. You may already suspect that cabin pressure is a culprit here. And you would be correct. In simple terms, the air pressure in your body (your sinuses, your ears, etc.) must equate to the air pressure in the cabin. And the air pressure in the cabin changes frequently — especially during ascent and descent (easily the most painful times for people who suffer from “airplane pain”). This is why people chew gum, suck on candy, swallow and try to “pop” their ears — essentially, they are trying to keep the pressure inside their sinus cavities consistent with the pressure outside. Well, the same principles apply to your teeth. There are instances where you have air trapped in your teeth and changes in pressure can make it hurt — and hurt badly. The two main reasons one would have air trapped in their teeth are decay and fillings (or other dental work). Let’s look at both: Decay: When a tooth starts to go bad, decay forms and essentially starts to eat away at the tooth. This will oftentimes bring air into the tooth. However, the openings for said air are microscopic (making it “trapped,” for all intents and purposes). When you go on a plane, this trapped air cannot keep up with the cabin pressure. Hence a toothache. A filling or other dental work: Sometimes air gets trapped in a filling or other dental work. Hence, the air, like the above example, really has nowhere to go. Or even if it can slowly escape, it cannot keep up with the rapid changes in cabin pressure. Also, older fillings can have microscopic gaps or holes that develop over time and lead to the same trapped air. One of the drawbacks of the “airplane toothache” is — unlike ear pain or sinus pain — there is little you can do to prevent it. In other words, chewing gum or swallowing isn’t going to relieve any pressure inside of your tooth. This makes air travel with a toothache a real problem. Yes, you can take painkillers, but this may or may not work as well as you want it to. It is also important to note that your upper teeth are positioned right underneath your sinuses. Sometimes, sinus pain can seem like tooth pain, when it really isn’t your teeth at all. So if the pain seems to be in an upper tooth, it could actually be your sinuses. If this is the case, you may be able to tell the difference, as the typical sinus remedies (gum, special earplugs, swallowing, etc.) may provide some relief. However, if you are certain that it’s your tooth, see your dentist as soon as you can. Because if it happened once, it’s likely going to happen repeatedly (which doesn’t make the return flight all that appealing, I’m sorry to say). If it’s a tooth that hasn’t had any work, it’s likely that something is amiss. If the tooth in question has had dental work, perhaps the dental work needs to be revisited. Either way, if you fly often, you’re going to want to get this checked out. Of course, it goes without saying that you should see your dentist if you have any inkling of tooth pain before your flight. Because the last thing you want is to start a vacation or important business trip with a terrible toothache. I have personally handled “emergency” work in my New York office for people who traveled to NYC. It might be helpful, before you go anywhere, to find the phone number of a dentist local to your destination who handles emergency-type work. This way, if a problem does arise, you have a number handy. Hey, it can’t hurt, right? Until next time, keep smiling!